I am a physician, financial planner, educator, and I love to tell great stories. The world is too complicated and doesn’t have to be that way. The goal for this blog is to bring simplicity to the two subjects I know best – financial planning and medicine.
My background - Med School at University of Mississippi and residency at the Medical College of Virginia. I taught at the University of Florida and worked in various emergency departments in the Jacksonville area.
In trying to find a financial planner, I went back to school for fun and found another passion. I founded Life Planning Partners, Inc. in 2004 and felt like I haven’t had a job since. I began sharing stories on the interplay of my two professions and am grateful for audiences all over the country who want to hear my message about medicine, money, and keeping it simple. Please join the conversation.

Cliffs Notes Version of the Affordable Care Act

Since the Supreme Court ruling on the Affordable Care Act in June, many people have taken a sudden interest in learning about the law. I originally posted this article in November, 2011. Today, I am updating this article with slightly deeper information, and some observations.

The law contains so much more than insurance reform. Changes in health care delivery, how we address chronic disease, and how we beef up our primary care workforce are included in the law. These changes are important to the infrastructure of our health care system and are sorely needed. Implore our leaders to think hard about the rhetoric of repeal – ask for implementation of the good sections and repair of the complex and convoluted mess of our insurance and billing system. We can do better.

So here is the update…

Since financial planners look to me to explain things related to health and finance, it was natural that I read the entire health care reform law. Fortunately, nothing excited me quite so much since reading the full version of “Paradise Lost.” This is really true – I enjoyed it. An overview of the law is important, and deeper articles can be found under the “Health Care Reform Reference Post.”

The law is 2,409 pages. For those of you who have never been privy to reading legislation, let me share a secret – they put very few words on a page. The document is double spaced, and each line is numbered to make it easy to reference which takes a lot of space. There was also a lot of fluff. What I thought would take me an eternity took a total of 40 hours. Yes, I timed myself. Doing follow up research is not included in that time, and I needed to do a lot of follow up. It is fascinating how so much of the law is not talked about in the press and how much is misrepresented.

There are ten “titles” in the law, each dedicated to a different part of our health care system. Today is an overview of those titles and subsequent posts will delve into the details, where the devil is of course.

Title I is “Quality Affordable Health Care for All Americans” and is 374 pages. This is the most important and widely discussed part, as it deals with health insurance. It is a very complicated section, and our leaders decided to make a complex and costly health care payment system more complex and costly.

It is important to understand how insurance will change. First, you cannot be turned down for coverage because you have an illness. Second, everyone is required to have coverage. It is the only way coverage is financially viable. Third, people who have difficulty affording coverage will get assistance paying for it unless they are under the 133% poverty level. Those people will go on Medicaid unless their state refuses to expand Medicaid.

To learn more details about the insurance provisions, Kaiser Family Foundation has a great primer with the basics.

Thank goodness the novel improves…

Title II is “Role of Public Programs” and deals with, you guessed it, public programs. Medicaid and the Indian Health Services are covered. There will be significant changes in how care is delivered. The exciting part of this provision is the development of medical care homes, which basically moves us from a paternalistic model of medicine to a team based approach, and the move to home based care for the chronically ill.

This is also the section of the law the Supreme Court had issue with – expanding Medicaid and withholding funding from states who won’t expand Medicaid. It will be interesting to see how this pans out.

Title III is the most important section for health care providers and details changes in Medicare. “Improving Quality and Efficiency of Health Care” dedicates 501 pages for changing how health care will be delivered. It moves us from a fee-for-service system toward payments based on quality of delivery. This starts with Medicare and what Medicare does is usually followed by private insurance. This will go a long way eventually toward controlling costs. When my audiences hear about the content in Title III, they want much of that part implemented.

Title IV is another section that gives me hope for the future. “Prevention of Chronic Disease and Improving Health” addresses the problem of chronic illness in our country. Chronic illness is very costly, and we need to do a better job of preventing disease or treating it very early before expensive complications arise. Actually, we really stink at that in our current health care delivery, and these 130 pages aim to change that. Many smart organizations were involved in this section of the law – Mayo Clinic and Kaiser Permanente to name a couple. This section of the law needs to stay.

Title V is what I call “The Jobs Bill.” It is actually the “Health Care Workforce” and the legislation in these 256 pages recognizes that we don’t have enough health care workers to take care of everyone. It especially addresses the lack of primary care in this country. Although we are all special, most of the problems we have don’t need a specialist to take care of them. Since we have rewarded specialty care through the years, the primary care system has been decimated. Countries with strong primary care systems have healthier populations with lower costs.

Title VI is 323 pages. “Transparency and Program Integrity” is dedicated to reducing fraud and abuse. Billions and billions are lost each year in this department and we definitely need to do something.

Title VII sounded very exciting when I looked at it – “Improving Access to Innovative Therapy” and is 65 pages basically dedicated to improving access to generic drugs. Innovative, indeed.

The one part of the law that was blatantly troublesome from the beginning was Title VIII “Community Living Assistance Services and Support.” This is basically a bill that instituted a federally run long term care insurance program. These 53 pages would have been a nightmare to implement because it created another system similar to our current Social Security disability system. This was Ted Kennedy’s baby, and although well intended, I wonder if the main reason this part passed was because of “The Lion’s” death during the construction of this law. Fortunately, this part of the elephant was put on the back burner because the HHS analysis revealed there would be many problems with implementation. Most likely, it will never be implemented. This also points out that we can change the law and don’t have to use energy to repeal it all and start over. I would appreciate all of you calling for total repeal to take note of that.

Title IX is the 93 page “Revenue Provisions” and spells out how we were going to pay for the elephant.

Title X was the most challenging, and it ended the novel like it began – complicated. Remember Title I, “Quality Affordable Health Care for All Americans?” Well, in the same law, we already had to strengthen it. Title X is called “Strengthening Quality Affordable Health Care for All Americans.” It really is called that. My name for it? “The Bucket List.” These 372 pages include a lot of neat pilot programs on changes in health care delivery, and the usual favors for special interests. There are two pages dedicated to gun owner rights and a provision that Nebraska doesn’t have to follow the Medicaid rules because that Senator would only vote for the law if his state was exempt. (It doesn’t say the information about the Senator but that is what happened.)

That is the health care law in a nutshell. Please ask questions, provide unbridled feedback, and please share this post with your friends. The more we can educate, the better decisions we can all suggest to our lawmakers. For further detail on these issues, please feel free to dive deeper on the “Healthcare Reform Reference Post.”

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Scott, Thanks for bringing that to my attention – as I said to Sheldon, it was repealed in my mind. :) I’ll fix it. I doubt the Administration will ever bring it up again – it was a bear of a provision.

I am a physician in practice since 1969.i would lie to read portions ofvthe ACA legisltion on my on. Where can I access the document for reading on or off line. I appreciate your great effort in reading for so masny hours and summarizing it so well. Thanks, F. Chevres,MD

Thank you so much for the kind words. My goal is to share what is in the law from a non-political stance. One thing that would have helped in the construction of the law is for the country to be clear on what they wanted from reform, which takes answering some difficult questions. Along the way of discussing what is in the law, I will ask the hard questions and we can determine which parts of the law answer those questions. When I discuss this in my speeches, most people find parts of the law they like and realize that we can adjust the parts that need improvement. Trying to repeal the law would be symbolic and a waste of energy we can use to fix what is not right with the law. I am grateful that in my travels, I find most people want to make the world a better place.

Carolyn, you are kidding right? When I googled “cliff notes on affordable healthcare” and your article came up, I was elated. Then I realized all you did was give the cliff notes on the topic of the different sections. Basically worthless! Your bio suggests you would be able to clarify many things for us in this bloated bill, but I guess that is actually above your pay grade. You act like you don’t want to interject politics and by interpreting this bill, I guess you think you would be. Too bad as it might have shed light on your cranial ability.

Can you tell me which section allows the Federal Government the right to inspect the financial records of any business they so desire at any time?

Gosh, I wish I could have broken down the law in one blog post, but then no one would have read it because of the length. I started with the article you read because most of this country thinks the law is just about insurance, and didn’t realize all the changes that will occur in regards to health care delivery. It was one big overview. However, I’ve gradually addressed different provisions in the law in subsequent articles, and I reference them all back to my “Health Care Reform Reference Post” http://www.forbes.com/sites/carolynmcclanahan/2011/12/22/the-health-care-reform-reference-post/

I’m trying to balance overloading people with information and educating them about the changes that will occur in our health care system. Maybe if we all understood the problems, we can come up with workable solutions that are appropriate for a great country like ours. Of course, I am hopeful we all want to do good things.

Thanks for reading and commenting. Best of life to you…

There is not a section in the law that allows the Government to inspect the financial records of any business. Glad I could help you out with that answer.